Food label knowledge : a comparison between a developing and developed country context

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Food label knowledge: a comparison

between a developing and developed

country context

SC Havenga

21047618

Dissertation submitted in fulfilment of the requirements for the

degree

Magister

in

Consumer Sciences

at the Potchefstroom

Campus of the North-West University

Supervisor:

Prof M van der Merwe

Co-supervisor:

Prof MJC Bosman

Co-supervisor:

Prof M Warnock

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Declaration

I, Susara Carolina Havenga, hereby declare that:

FOOD LABEL KNOWLEDGE: A COMPARISON BETWEEN A DEVELOPING AND DEVELOPED COUNTRY CONTEXT

is my own work and that this dissertation submitted for degree purposes at the North-West University has not previously been submitted for degree purposes to any other higher education institution and that, except for sources acknowledged, the work is entirely that of the researcher.

_____________________ SC Havenga

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Preface

The article format was selected for this dissertation. The study reported on in this dissertation was planned and executed by five researchers, and the contribution of each is acknowledged in the table below. A statement from the co-authors of the article (Chapter 3) is also included, confirming their role in the study and giving their permission for the inclusion of the article in this dissertation. The article is to be submitted to Cross-Cultural Research. A copy of the guidelines for authors of Cross-Cultural Research is included in Annexure F.

Name Role in the study

Ms SC Havenga Responsible for the literature searches, data collection, statistical interpretation, text drafting and writing of dissertation.

Prof. M van der Merwe Supervisor

Critically reviewed the article and dissertation

Prof. MJC Bosman Co-supervisor

Critically reviewed the article and dissertation

Prof. M Warnock Co-supervisor

Critically reviewed the article and dissertation Data collection in Fayetteville

Dr SE Ellis Responsible for statistical analysis

I declare that I have approved the above-mentioned article, that my role in the study as indicated above is representative of my actual contribution and that I hereby give my consent that this article may be published as part of the M dissertation of Ms SC Havenga.

_____________________ Prof. M van der Merwe

_____________________ Prof. MJC Bosman _____________________ Prof. M Warnock _____________________ Dr SE Ellis

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Acknowledgements

I would like to thank my Heavenly Father, for the ability, strength and passion He gave me to do this degree, as without Him nothing is possible.

Several people need to be thanked for their contribution to the completion of this dissertation, which would not have been possible without their assistance and support.

 Prof. Daleen van der Merwe, my mentor, thanks for all your guidance, care, patience and above all inspiration.

 Prof. Lena Bosman, thank you for your care and guidance.

 Prof. Mary Warnock, for data collection in Fayetteville and guidance.

 The strongest woman I know, Dr Marietjie Havenga, thank you for all the support, motivation, various proofreadings, thank you for your care, understanding and encouragement, especially for the motivation and example as a researcher.

 To my father and precious friend Kobus Havenga, thank you for your guidance, advice, motivation. Thanks for raising an inquisitive daughter.

 Dr Suria Ellis, for her patience and help with the statistical analyses of the data.

 My office friend, turning best friend Fraulein Fay Irvine, who supported me, thank you for all the laughter and statistical analyses on anything possible, the tremendous amount of Woolworths soup and Slim Slabs consumed.

 To Andre Gerber, thanks for being a great friend, and providing the necessary distraction when the going got rough. Thank you for all the time we spent dancing (causing you various injuries) purely for the benefit of uplifting my spirit.

 To the trendy Ruan Sheepelicious Kruger, for always listening.

 To the two Van den Berg brothers, Heinrich and Biella, you taught me about strength.  The National Research Foundation, for the financial input to make this project possible.  Thank you to Mrs A Lee, for language editing of my research proposal.

 Ms Jackie Viljoen, a brilliant language editor, with an exceptional talent and passion for language editing.

 Ms Genevieve Griffin, for her help with the data sampling.  Mr Shaun Liebenberg, for helping me study statistics.

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Opsomming

Die doel van hierdie studie was om die subjektiewe en objektiewe kennis van verbruikers in Potchefstroom (Suid-Afrika) en Fayetteville (Arkansas, VSA) rakende voedseletikette te bepaal en te vergelyk, teen die agtergrond van ’n ontwikkelende en ŉ ontwikkelde land. Die vraag is gevra of hulle kennis verskil en of verbruikers se demografie met hulle kennis in verband met voedseletikette verband hou. Geen spesifieke navorsing is tot dusver oor kennis rakende voedseletikette in ’n vergelyking tussen ’n ontwikkelende en ŉ ontwikkelde land gedoen nie.

’n Kwantitatiewe studie met doelgerigte steekproefneming is onder die respondente in hierdie verband gedoen deur middel van vraelyste wat tydens ŉ onderhoud ingevul is. Beskrywende en inferensiële statistiek is toegepas. Die totale steekproef (N = 713) het respondente van Suid-Afrika (’n ontwikkelende land) en die Verenigde State van Amerika (ŉ ontwikkelde land) ingesluit, met spesifieke verwysing na respondente van Potchefstroom (n = 400) en Fayetteville (n = 313). Die navorser het daarna gestreef om respondente uit elke etniese, demografiese, geslags- en ouderdomsgroep in te sluit.

Geen verskille is aangetref ten opsigte van die respondente se subjektiewe kennis (SK) van voedseletikette nie. Slegs prakties betekenisvolle verskille ten opsigte van objektiewe kennis (OK) vir die faktore rakende die opspoor van inligting (OK-L), manipulering van inligting (OK-M) met ’n soortgelyke patroon vir simboolinligting (OK-S) is met betrekking tot die respondente van Potchefstroom en Fayetteville bevind, alhoewel respondente van Fayetteville bogemiddelde tellings ten opsigte van OK-L, OK-M en OK-S gehad het. Dit dui daarop dat die respondente van Fayetteville meer kennis gehad het van hierdie faktore as respondente van Potchefstroom. In die studiepopulasie is goeie OK slegs onder goed opgeleide jong respondente van Potchefstroom waargeneem, terwyl respondente uit Fayetteville hoë kennisvlakke getoon het, ongeag hulle demografiese veranderlikes.

Daar is waargeneem dat die respondente van Potchefstroom nie oor soveel kundigheid (OK-L, OK-M en OK-S) beskik het as die respondente van Fayetteville nie. Die resultate van hierdie studie dien as bewys vir die behoefte daaraan om kennis rakende voedseletikette in die Potchefstroom-verband te verbeter, en bring soortgelyke behoeftes in ander ontwikkelende lande ter sprake. Daar kan tot die slotsom gekom word dat opvoedkundige pogings ontwikkel en geïmplementeer moet word met die doel om kennis rakende voedseletikette onder verbruikers van ontwikkelende lande te verhoog, aangesien OK ’n invloed op gesondheid het. Die ontwikkeling van opleidingsprogramme vir verbruikers moet fokus op kwesbaarheid soos geïdentifiseer met betrekking tot die betrokke ouderdomsgroepe en opvoedingspeil sowel as die

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probleme wat geïdentifiseer is ten opsigte van die inligting oor etikette en simbole waarvolgens verbruikers optimale kennis omtrent voedseletikette kan hê, asook hoe om hierdie etikette vir beter besluitneming en gesondheid te gebruik.

Hierdie navorsing oor kennis insake voedseletikette in Suid-Afrika en die Verenigde State van Amerika kan as grondslag dien vir toekomstige studies oor hierdie onderwerp in ontwikkelende en ontwikkelde lande. Dit kan bydra tot beter begrip van die faktore wat tot verbruikers in die ontwikkelende lande se verwarring, wantroue en ’n gebrek aan begrip van die inligting vervat in voedseletikette lei. Demografiese eienskappe, die lees van voedseletikette en gesondheidsverwante faktore wat tot beter kennis kan bydra kan ook verder ondersoek word tydens die ondersoek van spesifieke behoeftes onder sekere groepe in ontwikkelende lande ten opsigte van hulle kennis van voedseletikette.

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Abstract

The aim of this study was to determine and compare the subjective and objective food label knowledge of consumers from Potchefstroom (South Africa) and Fayetteville (Arkansas, USA), therefore in a developing and developed country context. The question was asked whether the knowledge of consumers in such contexts differed and whether consumers’ demographics are associated with their food label knowledge. No specific research on food label knowledge has been done in a comparative context between a developing and developed country previously.

A quantitative study using purposive sampling was conducted among respondents in these contexts by means of interviewer-administered questionnaires. Descriptive and inferential statistics were applied. The total study sample (N = 713) included respondents from South Africa (a developing country) and the United States of America (a developed country) with specific reference to respondents from Potchefstroom (n = 400) and Fayetteville (n = 313). The researcher strived to include respondents from each ethnic, demographic, gender and age group.

No differences were found regarding respondents’ subjective knowledge (SK) of food labels. With respect to respondents from Potchefstroom and Fayetteville, practically significant differences regarding objective knowledge (OK) were found only within the factors of locating information (OK-L) and manipulating information (OK-M) with a similar pattern for symbol information (OK-S), although respondents from Fayetteville had higher mean scores for OK-L, OK-M and OK-S, which indicates that respondents from Fayetteville were more knowledgeable on these factors than respondents from Potchefstroom. Within the study populations, better OK was only observed among respondents from Potchefstroom who were young and well educated, whereas respondents from Fayetteville had high levels of knowledge regardless of demographic variables.

It was observed that respondents from Potchefstroom were not as knowledgeable (OK-L, OK-M and OK-S) as respondents from Fayetteville. The results from this study serve as evidence for a need to improve food label knowledge in the Potchefstroom context, and raise the question about similar needs in other developing countries. It can be concluded that educational efforts should be developed and implemented to increase objective food label knowledge among consumers from developing country contexts, as OK may have an impact on health. Development of consumer education programmes should focus on the vulnerabilities identified with regard to age and education groups as well as the problems identified regarding label and

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symbol information provided, whereby consumers might acquire optimal food label knowledge to use these labels for improved decision-making and health.

This research about food label knowledge in South Africa and the United States of America, may serve as a foundation for future studies to be conducted in developing and developed country contexts. This might result in a better understanding about factors that contribute to consumers’ confusion, distrust and lack of understanding of food label information, which may hinder food label knowledge in developing country contexts. Demographic, label-reading and health-related factors that may contribute to increased knowledge could also be further explored in addressing specific needs among particular groups in developing country contexts regarding their food label knowledge.

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Keywords

Consumer Demographics Food labeling

Food label knowledge South Africa

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List of Acronyms

AHA American Heart Association

AIDS Acquired immunodeficiency syndrome CHD Coronary Heart Disease

DOH Department of Health

DV Daily Value

EC European Community

EU European Union

EUFIC European Union Food Information Council FDA Food and Drug Administration

g Gram

GED General Education Diploma

GMA Grocery Manufacturer's Association HIV Human immunodeficiency virus infection

kJ KiloJoule

KCAL KiloCalorie

KMO Kaiser-Meyer-Olkin

MG Milligram

MSG Monosodium glutamate

NLEA Nutrition Labelling and Education Act

OK Objective knowledge

OK-H Objective knowledge health claims OK-L Objective knowledge locating information OK-M Objective knowledge manipulating information OK-N Objective knowledge nutrient claims

OK-S Objective knowledge symbols SA South Africa

SK Subjective knowledge

SK-F Subjective knowledge food label information SK-G Subjective knowledge general information UK United Kingdom

USA United States of America

USDA United States Department of Agriculture WHO World Health Organisation

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List of Tables

Table 2-1 Demographic characteristics of South African (Potchefstroom) and USA

(Fayetteville) consumers ... 31

Table 2-2 Nutrition information mandatory to be provided on South African and American food labels ... 34

Table 2-3 Descriptions of food label claims as regulated in the United States of America ... 46

Table 2-4 South African and American food label symbols ... 48

Table 2-5 Educational groups of South African and United States of America consumers ... 57

Table 1 Reliability and validity for exploratory factor analysis of subjective and objective knowledge of food labels ... 86

Table 2 Frequencies and Distribution of Respondents’ Demographics ... 87

Table 3 Mean Subjective Knowledge of Respondents from Potchefstroom and Fayetteville ... 90

Table 4 Differences between percentages correct responses of respondents from Potchefstroom and Fayetteville regarding their objective knowledge with respect to different factors ... 91

Table 5 Objective knowledge of respondents from Potchefstroom and Fayetteville (% correct) regarding specific knowledge items ... 92

Table 6 Practically significant interaction effects found within the different study populations with regard to different OK factors ... 94

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List of Figures

Figure 1-1 Conceptual framework for a study concerning consumers’ food label

knowledge. ... 15 Figure 2-1 Theoretical framework for a study concerning consumers’ food label knowledge

(author’s own compilation). ... 30

Figure 2-2 An example of traffic light labelling on EU food labels ... 37 Figure 2-3 An example of a front-of-pack label on food products (Nestlé, 2012) ... 38 Figure 2-4 An example of a South African Typical nutrition panel (Kellogg’s, 2014) as

found on a food label ... 40 Figure 2-5 Example of a nutrition facts panel – USA (FDA, 2004) ... 41

Figure 2-6 Examples of food labels: sell by, best before and use by dates ... 50 Figure 2-7 Framework regarding the positioning of different types of knowledge within this

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Chapter 1: Introduction

1.1 Background and motivation

Food contributes significantly to consumers’ lifestyle, in providing pleasure and in fulfilling consumers’ energy and nutritional requirements (Drichoutis et al., 2008:141) through appropriate food choices. In order for consumers to make informed dietary decisions, they need nutrition information on food labels (Borra, 2006:1235S; Byrd-Bredbenner et al., 2000:615), as well as thorough food label knowledge, since these might influence their consumption patterns (Marietta et al., 1999:445) and overall health (Fusaro & Toops, 2012; Houston & Venkatesh, 1996).

Consumers’ understanding of food and food production and their attitudes towards health and diet form part of a multi-disciplinary and increasingly important research area in consumer science (Patermann, 2007 in EC, 2007). There is little literature regarding consumers’ food label knowledge in general and within the South African and United States of America consumer context in particular. Previous research (Block & Peracchio, 2006:188; Cowburn & Stockley, 2005:21; Drichoutis et al., 2006:1; Gorton et al., 2008:1359; Marietta et al., 1999:445) centred on consumers’ knowledge regarding nutritional information on labels, and not the overall knowledge of food labels. This lack in literature, the need in consumer science for information on consumers’ food behaviour (Patermann 2007, in EC, 2007) and the paucity of knowledge regarding food labels motivated this study. The only study on food label knowledge in the South African context was done by Van der Merwe et al. (2012). Anderson and Coertze (2001:28) did a similar study in the South African context; however, that was aimed at nutrition label knowledge.

1.1.1 Food labels as an information source

Consumers live in a world where communication options and their preferences of communication are expanding rapidly (Schiffman & Kanuk, 2010:20). Food labels are one of these communication resources and refer to any pictorial, brand, mark, tag, graphic or other descriptive matter, which is written, marked, stencilled, embossed, printed, impressed upon, or permanently attached to a container of a foodstuff (RSA, 2010:10). These labels are considered the most suitable source of information for consumers to acquire knowledge about food (Ali & Kapoor, 2009:725) and may thus serve as a valuable source of information for consumers.

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The primary role of food labels is –

 to inform consumers by communicating nutrition information (Mackinson et al, 2010:210);  to assist in selling food products by providing product information (Cheftel, 2005:531)

and

 to guide dietary behaviour (Lin & Lee, 2004:180; Mackinson et al., 2010:210; Tarasuk, 2006:1217).

Modern food labels are developed to inform consumers regarding factors such as food preservation technologies, mass industrial food production, and the development of packaging (Cheftel, 2005:531). Food label information thus has the potential to be transferred into knowledge about food and nutrition, and it serves as an educational source for consumers, especially with respect to those who might lack knowledge regarding nutrition (Barreiro-Hurle et al., 2008:190). In order for them to benefit optimally from food labels as an information source, consumers must consult the label, which can only occur if consumers have sufficient food label knowledge. Canavari and Nayga (2009:135) suggest that research should assess the main determinants of food label knowledge, which was addressed in the present study by determining associations of consumers’ food label knowledge together with their demographic and other general characteristics, and variables such as frequency of main grocery purchases.

1.1.2 Problems that consumers face regarding food labels

Consumers are challenged with increased availability of nutrition and health information on food labels (Barreiro-Hurle et al., 2010a:426), resulting in an information overload and a greater possibility of confusion (Lee & Lee, 2004:177). Consumers also tend to have a form of distrust in the accuracy and truthfulness of food labels (Misra, 2007:2131). Furthermore, research by Barreiro-Hurle et al. (2010a:426) suggests that consumers do not understand the information, although they demand nutrition and health information. It is thus imperative to understand which information consumers regard as important, what they understand, and what confuses them in order to determine consumers’ knowledge of food labels. By determining consumers’ food label knowledge, insight might be gained about the problems consumers face with regard to food labels, after which it can be attempted to bridge these problems. These possible problems or queries, as well as information regarding consumers’ knowledge of food labels might be used as a criterion for food label education programmes, or other attempts to increase consumers’ food label knowledge.

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1.1.3 The relevance of consumer behaviour in terms of food label knowledge

Consumer behaviour is the behaviour that consumers display when they use, purchase, evaluate, and dispose of products and/or services, which they expect to satisfy their wants and needs (Schiffman & Kanuk, 2010:23). Although consumer behaviour was not the concern of this study, certain types of food label behaviour might be influenced by consumers’ food label knowledge, or their behaviour might influence the acquisition of food label knowledge. Consumers’ expectations, motivation, use, purchase and consumption decisions as well as their memory and comprehension, which might influence food label knowledge, are subsequently discussed.

1.1.3.1 Consumers’ food label knowledge as linked to their expectations

Consumers expect food labels to provide accurate ingredient lists and health claims in order to make informed choices (Block & Peracchio, 2006:189). Food labels, however, have a limited function when consumers do not read, use or understand labels (Lin & Lee, 2004:33), or have insufficient knowledge of such labels. Therefore, this study attempted to provide insight about consumers’ food label knowledge. When consumers have knowledge of food labels, they may also become aware of certain expectations that they have regarding food labels. Although not addressed in this study, these expectations need to be met by the food industry to ensure consumer satisfaction (BCS, 2012; Sheth & Mittal, 1996:137).

1.1.3.2 Motivation to obtain food label knowledge

Motivation is the driving force of consumers, which moves them into action (Schiffman & Kanuk, 2010:106). This driving force is the product of a tension state, which is created by an unfulfilled need (Schiffman & Kanuk, 2010:107). When consumers’ needs are not fulfilled, it impels them to move into action; thus, motivating them to fulfil the specific need, such as the acquisition of food label knowledge. Once it is clear that their knowledge is not satisfactory, consumers might have intrinsic motivations to obtain knowledge (Osterloh & Frey, 2000:546), which might also be applied to food label knowledge. This motivation might not be restricted to obtain knowledge, but also to use food label information for various purposes, which might be health- and diet-related (Lin & Yen, 2008:437). Once consumers are, for example, aware of the prevalence of a disease, they might be motivated to modify their diets to inhibit the development of such a disease (Heimendinger & Van Duyn, 1995:1397S), which underscores the importance of food label knowledge and the need for research in this regard.

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1.1.3.3 Interaction between food label use and food label knowledge

Knowledge regarding a particular food product may convince consumers to use that product, although they might not prefer it, with respect to its taste and similar attributes (Wansink et al., 2004:266). Information found on food labels regarding quality, production and storage processes as well as nutrition is also important when determining the likelihood of consumers’ use of food labels (Ali & Kapoor, 2009:724), and in order to increase consumers’ label knowledge, their label use should increase (Drichoutis et al., 2005a:23). Conversely, consumers who have more food label knowledge are more likely to use these labels, and consider mandatory food labelling as beneficial (Garcia et al., 2007:161). Consumers who are more health and nutrition conscious are also more apt to use food labels (Drichoutis et al., 2006:i), which might, in turn, influence their nutrition label knowledge, and motivate them to acquire the necessary food label knowledge. Sufficient food label use may then occur for consumers’ benefit when they have adequate knowledge of food labels. Thus, food label knowledge may influence food label use, and vice versa.

1.1.3.4 Interaction between purchase and consumption behaviour and food label knowledge

Food label knowledge may assist consumers when making food-related purchases and consumption decisions. Consumers who read food labels are influenced by these labels during their purchasing decisions (Van der Merwe et al., 2012:403), in that they might use food labels to evaluate a food product before consumption (Borgmeier & Westenhoefer, 2009:184). Purchasing decisions can influence consumers’ consumption behaviour (Blackwell et al., 2006:70) by either changing or increasing the consumption of a product (Godwin et al., 2006:82), such as the increase of fruit and vegetables for a more healthy lifestyle (Heimendinger & Van Duyn, 1995:1397S). It can thus be expected that sufficient food label knowledge might positively influence food purchase decisions and consumption in favour of healthier product alternatives.

1.1.3.5 Memory and comprehension as part of food label knowledge

Memory, comprehension and knowledge are inseparable concepts. Memory can be divided into two sections: short-term memory (also referred to as “working memory”) and the long-term memory. The working memory may hold information for a brief period and can only store about seven items (Sternberg, 2006:165). However, long-term memory stores and retains information for extended periods (Schiffman & Kanuk, 2010:226).

Comprehension refers to consumers’ ability to understand the meaning of concepts and to interpret the required information (Wang & Garfurov, 2010:1). This definition of

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comprehension may also be applied to consumers’ comprehension of food label information. Several difficulties may be experienced when information is incompletely or incorrectly comprehended (Sternberg, 2006:160). Therefore it is important that food label information should be clear, correct and easily readable (EC, 2006:2) to enhance the possibility of comprehension of the label. Memory is needed for knowledge to reach its optimal potential, since knowledge gaps are defined as an “absence of information in memory” (Blackwell et al., 2006:363). The consumer should have memory of food label information in order to obtain knowledge in this regard. Memory will aid the consumer to comprehend food labels, since information cannot be obtained sufficiently to become knowledge if a concept is not comprehended (Carlson et al., 1992:129). Due to the importance of memory in establishing food label knowledge, the concept of memory could not be disregarded in the present study.

1.1.4 Education as resource to increase food label knowledge

Education efforts could be developed with the aim to increase consumers’ food label knowledge. These efforts should focus on improving consumers’ food label knowledge and bringing it in line with their personal food choices (Guenther et al., 2005:1273). These efforts should be aimed at consumers less likely to use nutrition labels (Garcia et al., 2007:172) in order to increase their knowledge in this regard. To ensure that consumer education occurs sufficiently, tailor-made education programmes should be developed for particular target markets (Unusan, 2004:636). Food label education programmes should start with nutrition background, which consumers may then implement during their label reading and purchasing (Van der Merwe et al., 2012:403). It is suggested that a food and nutrition labelling programme needs to be developed in South Africa (SA), as also requested by consumers (Anderson & Coertze, 2001:28), since there is no such programme available beacuse no program has been developed. Since consumers’ objective and subjective food label knowledge was determined in the present study, the possible need for food label education programmes among the consumer groups under investigation, was identified which could ultimately benefit consumers (see 4.6.1).

1.1.5 Health profile of South African and United States of America consumers as influenced by diet

The health profile of consumers from SA and consumers from the United States of America (USA) will be discussed subsequently.

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conducted on consumers’ health profile with regard to cardiovascular health (Malan et al., 2006:305), obesity (Kruger et al., 2001:86; Kruger et al., 2002:427; Kruger et al., 2005:365) and other health-related issues (Vorster et al., 2000:505) in the greater North-West province (NWP) of South Africa. There have been significant changes in consumers’ food consumption patterns in this province (Kruger et al., 2005:365). These dietary changes were associated with the urbanisation of consumers in the NWP (MacIntyre et al. 2002:249) and with changes in the prevalence of diet-related health concerns. A lack of variety often characterises lower-income consumers’ diets, since they have less access to stores with a wide range of foods at reasonable prices (Kruger et al., 2005:373). African consumers in the NWP with higher socio-economic status in wealthy areas have higher nutrition status, better health behaviours (in terms of HIV/AIDS infection, drinking and smoking), lower mean blood pressure and greater psychological wellbeing (Vorster et al., 2000:505).

Consumers within the urban areas in NWP have a higher resting blood pressure, higher hypertension prevalence and bigger vascular responsiveness than their rural counterparts (Malan et al., 2006:306). On the other hand, consumers who live in urban areas have a greater fat intake than rural consumers, which contributes to the increase in obesity (Kruger et al., 2002:427). The diets of consumers from rural areas and middle-class African consumers consist mostly of carbohydrates (65%), protein (12%) and fat (22%), and they have lower fruit and vegetable consumption than urban consumers. Urban consumers’ diets consist of 57% carbohydrate, 13% protein and 31% fat (MacIntyre et al., 2002:239). The protein composition of consumers’ diet in the rural group consists mostly of plant resources, which may suggest a risk of the lack of essential amino acids (MacIntyre et al., 2002:251).

Some diseases and dietary health concerns with regard to females, have come to the fore, such as obesity, which is associated with the risk of non-communicable diseases among African women in the NWP (Kruger et al., 2001:86). Among female consumers who have low levels of physical activity and a higher income, a greater susceptibility for obesity is possible, than among female consumers with greater physical activity and a lower income (Kruger et al., 2002:423). However, obesity is not the only diet disease-related illness; hypertension and impaired glucose tolerance are among other health-related issues, which are prevalent among female consumers from both rural and urban areas (Vorster et al., 2000:505).

More than half of the consumers in a study done by Kruger et al. (2005:365) had less than 67% of the recommended dietary intake of vitamin A, ascorbic acid, folic acid, iron, zinc and calcium. African consumers in this province have diets with low mineral intake (calcium and iron) and an overall low intake of milk and milk products, except among farm dwellers

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(MacIntyre et al., 2002:252). MacIntyre et al.’s research was done mainly among African consumers; thus, it is not clear what the general health profile of the entire population among all ethnic groups in NWP is.

1.1.5.2 Health profile of consumers in Arkansas in the United States of America

Research regarding consumers’ health profile done in the NWP (Kruger et al., 2001:86; Kruger et al., 2002:427; Kruger et al., 2005:365; Malan et al., 2006:305; Vorster et al., 2000:505) was more extensive than similar research in Arkansas (USA) (Arkansas Department of Health, 2008:9; Balamurugan et al., 2007:270; Tokar et al., 2003:170). A lack of disease awareness is associated with risk factors, which could account for some health differences among consumers, as found in Arkansas (Balamurugan et al., 2007:270). A prevalence of arthritis has been found among 32% of consumers in Arkansas (Balamurugan et al., 2007:270). There is also indications of osteoporosis and osteopenia in female college students in this state (Tokar et al., 2003:170). Consumers in Arkansas show some differences within their ethnic groups as to the level of their health status and the causes of health-related issues (Arkansas Department of Health, 2008:9). Caucasian consumers’ health concerns are associated with tobacco; among African-American consumers, it is cancer, heart disease, HIV/AIDS, oral health and physical activity; and among Latinas, it is the occurrence of diabetes (Arkansas Department of Health, 2008:9). Since less research was found regarding the health profile of consumers in Arkansas than about consumers’ health profile in the NWP, it is difficult to compare consumers from both these countries from a health profile perspective, since less research based findings are available for comparison. It can, however, be summarised that the following diseases, which are relevant to this study, are associated with diet and foods consumed and are prevalent among consumers in both the NWP and Arkansas:

 arthritis (Messier et al., 2004:1501);  osteoporosis (Prentice, 2004:227);  cancer (Brown et al., 2013:360),

 coronary heart disease (CHD) (Bernstein et al., 2010:876);  diabetes (Jönsson et al., 2013:105);

 hypertension (Sacks & Campos, 2010:2102);

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 oral health problems (Wu, 2012:270); and  osteopenia (Cellier et al., 2000:806).

Consumers who have good knowledge about nutrition and food labels are also concerned about their health (Kolodinsky et al., 2007:1409; Sääksjärvi et al., 2009:138), which in turn has an influence on their use of nutrition labels (Barreiro-Hurle et al., 2010b:222). Food labels cannot be used effectively if consumers do not have knowledge about the information provided on these labels. Van der Merwe et al. (2012:12) state that healthy dietary behaviour can be promoted by educating consumers to make nutritionally appropriate choices. Nutrition information and mandatory food label information on food packages are sources by which consumers can improve their dietary choices and health (Borra, 2006:1235S; Stuart, 2010:27). The new labelling legislation in SA was developed with the expectation that it might help consumers to obtain and sustain a healthy lifestyle from the food choices that they make (Kempen et al., 2011:69). Consumers’ health status could motivate them to improve their food label knowledge since they might realise the importance of both a healthy lifestyle and the benefits of having food label knowledge and the way these support each other (Barreiro-Hurle et al., 2010a:426; Barreiro-Hurle et al., 2010b:221; Fitzgerald et al., 2008:960; Hess et al., 2011:407).

1.1.5.3 Food label knowledge and health maintenance

The quadruple burden of disease experienced in SA includes communicable, non-communicable, maternal and perinatal, and injury-related disorders (Mayosi et al., 2009:934). Non-communicable diseases include diseases such as cancer, chronic heart disease, chronic lung disease, diabetes, and high blood pressure (RSA, 2011:8). These diseases are emerging among poor consumers in both urban and rural areas (Mayosi et al., 2009:934), due to risk factors including alcohol, smoking, poor diet and a lack of exercise (RSA, 2011:8), which increase pressure on chronic and health-care services (Mayosi et al., 2009:934). Food labels might support consumers in their purchasing patterns (McEachern & Warnaby, 2008:414) and food consumption (Marietta et al., 1999:445); it therefore sustains a healthy lifestyle which could prevent the development of some diseases (Barreiro-Hurle et al., 2010a:426; Barreiro-Hurle et al., 2010b:221; Hess et al., 2011:407). Determining consumers’ food label knowledge in the present study might result in efforts aimed at increasing consumers’ knowledge. This will assist them in making more informed food choices to prevent nutrition-related diseases. Consumers’ knowledge of food label information about synthetic ingredients (such as monosodium glutamate, also known as MSG) may assist them in avoiding the consumption of these ingredients that do not promote

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a healthy lifestyle (Botes, 2011). Consumers’ knowledge of ingredients might reduce their risk of developing diseases, such as the knowledge that omega 3 fatty acids may reduce the risk of heart disease (Kris-Etherton et al., 2003:151). Combined with food label knowledge this might help them to choose the most suitable option for health benefits. To maintain healthy diets, consumers should thus understand the importance of all food label information and not only information regarding kilojoules and macronutrients (Kolodinsky et al., 2008:298), which necessitates food label knowledge.

1.1.5.4 Food label knowledge and obesity and overweight

The diet-related health (Patermann, 2007, in EC 2007) and developing country (WHO, 2003) scene is currently dominated by a rise in the prevalence of obesity, while an increase in food-related illnesses such as obesity and diabetes is also found among consumers (McLean-Meyinsse & Summers, 2008:94). In South Africa 61% of the population is overweight, obese or morbidly obese, while 71% of these consumers have never dieted and 49% do not exercise (Smith, 2010). In addition, 17% of children in SA are also overweight (Smith, 2010). Moreover, there has been a distressing increase in the frequency of obesity in the USA over the past 20 years (Centres of Disease Control and Prevention, 2012) to such an extent that obesity has become a matter of public health concern (Lando & Labiner-Wolfe, 2006:157). In the USA, 35.7% of adults and approximately 17% of children (aged 2– 19 years) are obese (Centres of Disease Control and Prevention, 2012). With the increase of obesity in SA and the USA together with the health risks associated with being overweight, food label knowledge may assist consumers in maintaining a healthy weight and lifestyle as they can use food labels as a source to adapt their dietary choices for weight control.

1.1.6 Necessity of doing a study in a developing and developed country

Consumer knowledge has been studied within a wide variety of domains (Carlson et al., 2008:864), although most theories regarding consumers’ knowledge have been established in Western countries (Guo & Meng, 2008:260), suggesting that research is not necessarily representative of the global consumer. The present study aimed to compare consumers from Potchefstroom (NWP, SA) and Fayetteville (Arkansas, USA); thus, a developing and developed country respectively. A developing country has a clear focus on agricultural outputs (Mosby, 2008), whereas a developed country focuses on manufacturing and technology (Mosby, 2008). SA has an emerging economy (SAinfo, 2012b), focusing on agriculture, manufacturing, and technology. Furthermore, significantly more previously disadvantaged South-Africans nowadays have access to commodities and services (Gothan

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study comparing consumers from a city in this country to those of a city in a developed country context (USA) regarding food label knowledge was thought to be valuable.

According to Van der Merwe et al. (2012:404), international consumer research is not directly relevant to the unique South African environment. The knowledge of South African consumers with regard to food labels thus needed to be researched, although more research has been conducted in the NWP than in Arkansas, more label research has been done in the general USA context than in the South African context. As mentioned in 1.1, only Anderson and Coertze (2001:28) and Van der Merwe et al. (2012:403) have studied consumers’ nutrition and food label knowledge respectively in the South African context. In the USA context, the following studies have been reported regarding consumers and various aspects of food labels and knowledge:

 consumers’ knowledge of health claims on food labels (Fullmer et al., 1991:166);

 consumer food label knowledge and other consumption behaviour (Biing-Hwan & Yen, 2008:437; Kim et al., 2001:10; Lin & Yen, 2008:437; Walters & Long, 2012:350);

 nutrition knowledge of nutrition information found on food labels (Drichoutis et al., 2005b:93; Grunert et al., 2010:177; Nayga, 2000:97);

 student consumers’ knowledge on food labels (Nurliyana et al., 2011:1); and

 consumers’ food label knowledge with regard to health-related issues (Miller & Achterberg, 2000:43; Tessier et al., 2008:35).

It is evident that several studies have been done with regard to food label knowledge in the USA context, but most of these focused on aspects such as claims, consumption behaviour, nutrition knowledge, student consumers, and other health aspects, and not on overall food label knowledge.

From the above discussion, a lack of research regarding a comparison of consumers’ food label knowledge in a developing (South Africa) and a developed country (United States) became clear. A similar study was done regarding nutrition labels in a developing country (Brazil) and a developed country (Germany) (Soriano et al., 2012), where it was found that the respondents in the developed country did not have better knowledge regarding nutrition labelling than those in the developing country. It is, however, necessary to determine consumers’ knowledge regarding the information on the entire food label in making healthy food choices and not only choices regarding nutritional information. Furthermore, the SA and USA contexts might differ from those of Brazil and Germany due to differences such as demographics and label regulations, and this needs further investigation.

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Consumers in SA, as a developing country, do not hold the same education levels and opportunities as USA consumers (Nation Master, 2012). Consumers’ knowledge regarding food labels in a SA or USA context thus had to be determined, to establish whether such knowledge reflects consumers’ unique education needs. This was done in order to develop education programmes, which might be used in developing and developed countries for the purpose of obtaining and improving food label knowledge. Although SA is a developing country, access to education efforts has increased over the past few years with a greater investment by government (Media Club South Africa, 2012). These educational efforts might decrease the differences in the levels of consumers’ knowledge of food labels between the two countries of interest for this study. Furthermore, food labels on products have increased globally over the past few years, as consumers insist on more label information to be available (Bernués et al., 2003:1095; Wang et al., 1995:368). The availability of food label information might affect consumers’ knowledge of food labels in a developing and developed country context differently.

In both SA and the USA, more educational opportunities are available than before with an increase in educational efforts in the USA, such as home schooling, internet courses, and smaller colleges for consumers (Education USA, 2012), while the general consumer also experiences an increase in opportunities to obtain an education in SA (SAinfo, 2012a). South Africa thus has some characteristics similar to that of a developed country (Kinsey, 2006:142) such as a productive and industrialised economy. The country is however still classified as a developing country, with characteristics such as a labour division between formal and informal sectors and an uneven distribution of income (Global Literacy Project, 2012), as well as the population of unemployed South Africans (Du Toit, 2003:6). It was considered that a study in the South African and USA contexts on respondents’ food label knowledge might contribute to identifying areas that need improvement.

A comparison between respondents from Potchefstroom (NWP, SA) and Fayetteville (Arkansas, USA) seemed plausible since these cities have similarities regarding:

 being cities with universities, the North-West University in Potchefstroom (SA) (NWU, 2012) and the University of Arkansas in Fayetteville (UA, 2012) (USA);

 equal gender distributions (CLR, 2010; Statssa, 2012)

 age distributions with the majority being 15–64 years of age (CLR, 2010; Stassa, 2012), which is the age group of school learners, university students and people below the age of retirement.

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One major difference between the two cities is, however, the ethnic distribution in the two cities. Potchefstroom (NWP) has a large population of African consumers (Statssa, 2012) compared to Fayetteville (Arkansas), where the majority of the consumers are Caucasian (CLR, 2010).

1.1.7 Necessity of a study on consumers’ food label knowledge

This study of consumers’ knowledge of food label did not only determine their level of knowledge, but also identified areas where food label knowledge might be improved. In order to understand food labels, it is therefore suggested that consumers should have a basic knowledge of food label information, although extensive knowledge would be ideal. By understanding consumers’ food label knowledge, the consumer scientist and consumer researcher may have a better understanding of these consumers’ behaviour. Borra, (2006:1235S) states that consumers have mixed feelings on food labels. Some consumers believe that labels are too complicated and should be easier to use, while other consumers find labels useful in order to make better food choices. Food label knowledge may thus assist consumers in bridging these mixed feelings.

It would be beneficial for the consumer to rely on the nutrition label information rather than on their own knowledge of a food product (Drichoutis et al., 2006:4), since the latter might be influenced by their subjective knowledge. Subjective knowledge is measured with reference to consumers’ self-reported knowledge about a product or domain (Raju et al., 1995:154). Subjective knowledge, as a self-generated knowledge without any objective verifications, may cause some consumers to make decisions in irrational or intuitive ways (Guo & Meng 2008:266). Consumers can use their (objective) nutrition knowledge as a way to seek and acquire nutrition information regarding food products (Drichoutis et al., 2008:140). Conversely, it is also possible that nutrition labels might influence nutrition knowledge (Drichoutis et al., 2006:6), whereas nutrition label use may be a source of information in obtaining this knowledge. This may also be applicable for food label knowledge, as the researcher aimed to determine in the present study.

1.2 Problem statement

Non-communicable diseases and obesity are becoming an increasing threat to consumers in developing and developed countries, such as SA and the USA. In order to benefit optimally from food labels as a source of information to make informed dietary decisions, consumers have to consult labels. This can only occur once consumers have sufficient food label knowledge. Consumers’ effective use of food labels is, however, challenged by an overload of information, confusion, distrust, and lack of comprehension regarding label information.

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The incorrect or incomplete comprehension of label information might also be identified as a challenge to consumers when trying to use the information. Furthermore, non-use of labels or ignorance would deprive consumers from benefiting from label information provided. Some of these challenges might be overcome by improved food label knowledge and in some instances, this might even increase consumers’ use of food labels to make informed food choices. However, it is important that this knowledge be reflective of consumers’ objective label knowledge and not their subjective knowledge, since the latter is based on what consumers think they know and not their actual knowledge. Therefore, this might result in irrational or intuitive decisions. It is thus evident that consumers’ objective knowledge of food labels could benefit them on several levels. The difference between consumers’ subjective and objective knowledge stresses the necessity of research in this regard, especially since research on consumers’ knowledge of food labels is sparse in the context of a developing (SA) and developed (USA) country. Existing research focused mostly on the nutrition information on labels. Consumers’ knowledge regarding other label aspects such as ingredients might, however, also benefit them when making decisions regarding aspects such as allergens. Research regarding consumers’ knowledge of all label information is therefore required.

As a developing country, SA faces several problems that characterise developing countries, but since this country is also recognised as an emerging economy and because previously disadvantaged consumers have more access to the consumer market than before, more consumers have access to the formal retail sector and products with food labels. South African consumers might therefore show similarities to consumers in a developed country such as the USA, even though the demographic profiles of these countries differ vastly. Furthermore, more South Africans have access to education than before, which might result in better food label knowledge among consumers in this country, as the level of food label knowledge expected in the USA, but consumers in the SA context still do not have the same opportunities as in the case of the USA a developed country.

The presence of food labels and the amount of information on those labels have increased globally, due to consumers’ need for access information. The question arises as to which extent consumers in both a developing and a developed country context have sufficient knowledge regarding such labels to allow them to make use of the abundance of label information in order to make healthier food choices.

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1.3 Aim, objectives, research question and theoretical framework

The aim, objectives, research question and theoretical framework will be discussed subsequently.

1.3.1 Aim

The aim of this study was to compare the food label knowledge of consumers in the context of a developing country (Potchefstroom, NWP, SA) and a developed country (Fayetteville, Arkansas, USA) to determine whether there is a difference between the food label knowledge of these consumers.

1.3.2 Objectives

In order to reach the aim stated above, the following objectives were applicable, namely to determine:

 whether and how the objective and subjective food label knowledge of consumers from Potchefstroom (NWP) and Fayetteville (Arkansas) differs;

 the association between the subjective and objective knowledge of consumers from Potchefstroom (NWP) and Fayetteville (Arkansas); and

 whether and how the demographic variables of consumers from Potchefstroom (NW) and Fayetteville (Arkansas) are associated with their objective and subjective food label knowledge.

1.3.3 Research questions

 Does the objective and subjective food label knowledge of consumers from Potchefstroom (NWP) and Fayetteville (Arkansas) differ and if so, how?

 Is the subjective and objective knowledge of consumers from Potchefstroom (NWP) and Fayetteville (Arkansas) associated and if so how?

 Are the demographic variables of consumers from Potchefstroom (NWP) and Fayetteville (Arkansas) associated with their objective and subjective food label knowledge and if so, how?

1.4 Theoretical framework

The conceptual framework for the present study explains the basic concepts relevant to consumers’ food label knowledge and the interrelationship between these concepts and food label use in this study (Figure 1-1). As mentioned before, for the purpose of this study, consumers will be viewed in a developing country context, namely SA and a developed country context, namely the USA. Consumers who are exposed to food labels might have a need to obtain information regarding these labels; thus, a need exists to acquire food label

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knowledge. Consumers in developing and developed countries, such as SA and the USA, have unique demographic characteristics. Although some of these characteristics might be the same, such as the age or gender distribution, other demographic characteristics such as language and ethnicity, which are country-specific, might differ. Food labelling is regulated by different regulations and legislation, depending on the relevant country. These regulations often stipulate the format in which food label information is to be provided. Information of food labels presents the allergens, claims, expiry date, ingredients, manufacturer, mass, nutrition, serving size, storage instructions and usage instructions. Consumer knowledge can be categorised into objective and subjective knowledge (see Chapter 2). In order for optimal food label knowledge to be obtained, label information should be comprehended with the information stored in the memory for later retrieval. In turn, regular food label use might increase consumers’ knowledge regarding food labels.

Figure 1-1 Conceptual framework for a study concerning consumers’ food label knowledge.

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Food label knowledge : a comparison between a developing and developed country context